The Landscape of Skilled Service Justification in Skilled Nursing Facilities

Skilled Service Justification in SNFs In the ever-evolving landscape of skilled nursing facilities (SNFs), the stakes have never been higher. With constant advancements in data analytics, regulatory bodies are sharpening their focus on compliance and accountability...

Ask Proactive – I have a resident that routinely receives an injection of fluphenazine decanoate every 4 weeks. The injection was not administered during the 7-day observation period, but its a long-lasting medication. Should I code it under N0415A?

Q: I have a resident that routinely receives an injection of fluphenazine decanoate every 4 weeks. The injection was not administered during the 7-day observation period, but its a long-lasting medication. Should I code it under N0415A?     A: Page N-9 of...

Ask Proactive – We have a resident with a chronic stage IV pressure ulcer who recently had flap surgery to close the wound. Do I continue to code the stage IV on the MDS?

Q: We have a resident with a chronic stage IV pressure ulcer who recently had flap surgery to close the wound. Do I continue to code the stage IV on the MDS?     A: According to the RAI (pg. M-6), if a pressure ulcer is surgically closed with a flap or...

Ask Proactive – Our social worker attempted to complete the BIMS with a resident, but the resident refused to answer the questions. As a result, the social worker coded all responses in C0200, 0300 and 0400 as “0” with a BIMS Summary Score of “00” at C0500. This seems odd because the resident’s previous BIMS scores have been 14 or15. When I interact with the resident, I don’t observe any cognitive decline, and the staff report no concerns either. Is this BIMS coding correct?

Q: Our social worker attempted to complete the BIMS with a resident, but the resident refused to answer the questions. As a result, the social worker coded all responses in C0200, 0300 and 0400 as “0” with a BIMS Summary Score of “00” at C0500. This seems odd because...

Ask Proactive – My facility is triggering high for the Quality Measure: Prevalence of Behavior Symptoms Affecting Others, but we don’t have many behavioral issues in our population. Why is this happening?

Q: My facility is triggering high for the Quality Measure: Prevalence of Behavior Symptoms Affecting Others, but we don’t have many behavioral issues in our population. Why is this happening?     A: This measure may trigger if the most recent MDS is coded...